RESUMEN
An unusual esophageal tumor in a 58-year-old man complaining of dysphagia and weight loss is herein described. Esophageal radioscopy and endoscopy visualized a huge polypoid tumor which was occluding the esophagus. After esophageal resection, the histological examination revealed miscellaneous benign cells (squamous, columnar fat cells, cartilaginous cells, and glandular structures) and two different malignant areas (spindler sarcomatous cells and squamous cells). There was no malignant invasion in the stalk, in the adjacent esophageal wall, or in the periesophageal tissue, and there were no malignant adenopathies. The postoperative course was favorable for one year, until the patient developed pain in the right superior back. A sarcomatous relapse was diagnosed by fine-needle biopsy under CT guidance, and the patient subsequently received radiation therapy.
Asunto(s)
Carcinosarcoma/patología , Neoplasias Esofágicas/patología , Anciano , Humanos , MasculinoRESUMEN
Efficient esophageal clearance has an important defence role in the pathogenesis of the gastroesophageal reflux disease (GERD). Many GERD patients have esophageal disturbances associated with or secondary to reflux, producing delayed clearance. This delay exposes the esophageal mucosa to the reflux acid content. To determine esophageal transit we scanned the esophageal transit of a 15 ml bolus containing colloidal 300/cCi 99m Tc. The esophageal transit was calculated in seconds according to formula E.T. = T 1/2 x 5. The study included 74 GERD patients. The following investigations were carried out in all the cases: esophageal X-ray, GER scintigram, endoscopy, esophageal biopsy, Bernstein test and esophageal transit scintigram. Endoscopy revealed lesions of the esophagus (of 1st, 2nd and 3rd degree) in 39 patients, Barrett syndrome in 8 cases and normal in 27. Esophageal transit scanning was normal in 18 cases (24%), and prolonged in 56 cases (76%). Only 7 (39%) of the 18 patients with a normal transit presented lesions of the mucosa, the latter being more frequent in patients with a prolonged transit, i.e. 40 of 56 patients (71.5%). The mean value of the transit in different degrees of esophagitis (I, II, III) and Barrett syndrome were: 12.73 +/- 5.36; 13.30 +/- 7.90; 10.35 +/- 5.78; 17.25 +/- 11.17. In conclusion esophageal transit scanning is a useful test in GERD patients as it has a prognostic value. A prolonged esophageal transit is frequently associated with lesions, the more severe the slower is the transit. Moreover the test may indicate certain drugs acting upon the esophageal motor disturbances.
Asunto(s)
Esófago/diagnóstico por imagen , Reflujo Gastroesofágico/diagnóstico por imagen , Tránsito Gastrointestinal/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Esófago de Barrett/diagnóstico , Esófago de Barrett/fisiopatología , Biopsia , Esofagitis/diagnóstico , Esofagitis/fisiopatología , Esofagoscopía , Esófago/fisiopatología , Femenino , Reflujo Gastroesofágico/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , CintigrafíaRESUMEN
Subtotal and total colectomy was the choice therapeutic solution for multiple colonic cancer, diffuse rectocolonic polyposis, multiple colonic polyposis, ulcerohaemorrhagic rectocolitis, and for two rare diseases; megacolon with extensive atrophy of lymph nodes, and acute ischaemia of the colon. A total of 35 cases are reported. Ileorectal anastomosis was the method used for this type of intervention. The opportunity of rectal conservation is discussed, in cases of rectocolonic polyposis and ulcerative haemorrhagic rectocolitis. The difficulty of making an optimal choice in complicated forms of ulcerohaemorrhagic rectocolitis is exemplified with the aid of clinical observations.
Asunto(s)
Colectomía/métodos , Enfermedad Aguda , Adulto , Colitis Ulcerosa/cirugía , Colon/irrigación sanguínea , Neoplasias del Colon/cirugía , Pólipos del Colon/cirugía , Femenino , Humanos , Isquemia/cirugía , Masculino , Megacolon/cirugía , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugíaAsunto(s)
Antiulcerosos/uso terapéutico , Bismuto/uso terapéutico , Úlcera Duodenal/tratamiento farmacológico , Compuestos Organometálicos/uso terapéutico , Ranitidina/uso terapéutico , Método Doble Ciego , Evaluación de Medicamentos , Femenino , Humanos , Masculino , Comprimidos , Factores de Tiempo , Cicatrización de Heridas/efectos de los fármacosAsunto(s)
Várices Esofágicas y Gástricas/etiología , Hemorragia Gastrointestinal/etiología , Hipertensión Portal/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía , Várices Esofágicas y Gástricas/diagnóstico , Femenino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Rotura EspontáneaAsunto(s)
Adenocarcinoma/etiología , Colitis Ulcerosa/complicaciones , Neoplasias Colorrectales/etiología , Adenocarcinoma/patología , Adulto , Niño , Colitis Ulcerosa/patología , Colon/patología , Neoplasias Colorrectales/patología , Femenino , Humanos , Mucosa Intestinal/patología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Recto/patologíaAsunto(s)
Intestinos/anomalías , Intestinos/irrigación sanguínea , Adolescente , Adulto , Anciano , Niño , Diagnóstico , Femenino , Humanos , Intestinos/cirugía , Masculino , Persona de Mediana Edad , SíndromeRESUMEN
The present paper reports on two cases of gastric lymphomatosis whose diagnosis could only be established by histologic examination of the operative specimen. Benign gastric lymphomatosis (BGL) is characterized by lymphoid infiltration of the gastric wall, predominant in the mucosa and sometimes in the submucosa, running a slow benign course. It must be differentiated from malignant gastric lymphomas and from inflammatory lymphoid reactions surrounding ulcers. BGL have not been treated medically to date. One of the patients initially underwent an eight months treatment with prednisone, then with prednisone and cytostatics, which resulted in clinical improvement but did not modify the pathohistologic picture. As BGL represents a precancerous state and cannot be controlled at present by any medical treatment, the surgical intervention is considered opportune.